Zhou Nina, Guo Xiaoyi, Sun Hongwei, Yu Boqi, Zhu Hua, Li Nan, Yang Zhi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China.
United Imaging Research Institute of Intelligent Imaging, Beijing, China.
Front Oncol. 2021 Nov 9;11:714948. doi: 10.3389/fonc.2021.714948. eCollection 2021.
The aim of this study was to evaluate the clinical value of simultaneous positron emission tomography/computed tomography (PET/CT) and abdominal positron emission tomography/magnet resonance imaging (PET/MRI) in the detection of liver metastases and extrahepatic disease (EHD) in patients with potentially resectable colorectal liver metastases (CLM).
Fifty-six patients with CLM underwent conventional imaging (chest and abdomen CT, liver contrast-enhanced CT or MRI) and PET imaging [fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT and subsequent liver PET/MRI] for staging or restaging. Diagnostic ability of PET imaging was compared with conventional imaging. Abnormal findings were correlated with follow-up imaging and/or histology. The influence of the PET imaging findings was categorized for each patient in relation to operability and other significant findings. The clinical management included three modalities (surgery for resectable CLM, unresectable CLM with conversion treatment, and systemic therapy). The clinical impact of the imaging modality was analyzed. The operative histopathological analysis and/or imaging follow-up were performed as the standard of reference.
This study enrolled a total of 56 patients (median age 60 years, 62.5% were male, 36 with colon cancer and 20 with rectal cancer). For EHD detection, PET/CT detected more EHD than conventional imaging (60.7% 46.4%). PET/CT had different findings in 19 (33.9%) patients, including downstaging in 4 (7.1%) patients and upstaging in 15 (26.8%) patients. For liver lesion detection, PET/MRI showed comparable detection ability with CE-MRI and CE-CT (99.5%, 99.4%, and 86.5%, respectively) based on lesion analysis, much higher than PET/CT (47.5%). PET imaging had a major impact in 10/56 (17.9%) patients (4 from unresectable to resectable, 6 from resectable to unresectable) and a minor impact in 4/56 (7.1%) patients for changing the surgery extent. The therapeutic strategies had been altered in a total of 14/56 patients (25%) after PET/CT and PET/MRI scans.
The results of this study indicate that simultaneous F-FDG PET/CT and abdominal PET/MRI scans can provide accurate information regarding CLM status and EHD, and can affect the management of 25% of the patients by changing the therapeutic strategies determined by conventional imaging. This new modality may serve as a new one-stop method in patients with potentially resectable CLM.
本研究旨在评估同时进行正电子发射断层扫描/计算机断层扫描（PET/CT）和腹部正电子发射断层扫描/磁共振成像（PET/MRI）在检测潜在可切除的结直肠癌肝转移（CLM）患者的肝转移和肝外疾病（EHD）中的临床价值。
56例CLM患者接受了传统成像检查（胸部和腹部CT、肝脏增强CT或MRI）以及PET成像检查[氟-18氟脱氧葡萄糖（F-FDG）PET/CT及随后的肝脏PET/MRI]以进行分期或重新分期。将PET成像的诊断能力与传统成像进行比较。异常发现与后续成像和/或组织学结果相关。针对每位患者，根据可操作性和其他重要发现对PET成像结果的影响进行分类。临床管理包括三种模式（可切除CLM的手术、不可切除CLM的转化治疗以及全身治疗）。分析成像模式的临床影响。以手术组织病理学分析和/或成像随访作为参考标准。
本研究共纳入56例患者（中位年龄60岁，62.5%为男性，36例患有结肠癌，20例患有直肠癌）。对于EHD检测，PET/CT检测到的EHD比传统成像更多（60.7%对46.4%）。PET/CT在19例（33.9%）患者中有不同的发现，包括4例（7.1%）患者分期下调和15例（26.8%）患者分期上调。对于肝脏病变检测，基于病变分析，PET/MRI显示出与CE-MRI和CE-CT相当的检测能力（分别为99.5%、99.4%和86.5%），远高于PET/CT（47.5%）。PET成像对10/56（17.9%）例患者有重大影响（4例从不可切除变为可切除，6例从可切除变为不可切除），对4/56（7.1%）例患者改变手术范围有轻微影响。在PET/CT和PET/MRI扫描后，共有14/56例患者（25%）的治疗策略发生了改变。
本研究结果表明，同时进行F-FDG PET/CT和腹部PET/MRI扫描可以提供有关CLM状态和EHD的准确信息，并可通过改变传统成像确定的治疗策略影响25%患者的管理。这种新的模式可能成为潜在可切除CLM患者的一种新的一站式检查方法。
